VA partners with DOD to bring hearing to veterans

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VA Southern Nevada is now partnering with the Department of Defense to provide comprehensive cochlear implant services for veterans.

Through this partnership, patients who qualify for the device receive their pre-procedural consultations, post-operative follow-up care, and programming with an Audiologist at the VA Medical Center, while the operation is performed by an Ear Nose and Throat Specialist/Otolaryngologist at the Michael O’Callaghan Military Medical Center on Nellis Air Force Base, Nev.

Cochlear implants are the only audiological specialty within the VA that requires approval by the VHA Cochlear Implant Advisory Board. VASNHS Audiologist Dr. Jemila Fairley had cochlear implant expertise, but the VASNHS Medical Center was not yet approved to provide cochlear implant programming or surgical services locally. Thus, all local veterans had to travel to Long Beach VA Hospital in Southern California for all cochlear implant related services. All of this changed after the VASNHS applied to become an official programming center and was approved on Sept. 8, 2017. In an effort to create a holistic team approach, Dr. Anna Tsai, Otolaryngologist at Nellis AFB, agreed to perform the medical consultations and surgical procedures at their facility as part of our Joint Venture. With the advisory board’s blessing to move, the first suitable candidate was selected and implanted locally.

Timothy Dolan is the first recipient of a cochlear implant thanks to this partnership.

While he had been wearing standard hearing aids for several years, Dolan was open to trying a new option.

“I’ve been gradually losing my hearing all my life,” Dolan said. “But it has been really bad over the last two years.” In December 2017, Tsai and Dr. Jemila Fairley suggested the option of a cochlear implant. After months of consultations and pre-procedural appointments, the 69-year-old Army veteran underwent cochlear implant surgery on Sept. 6, 2018 at Nellis AFB, and the device was activated Oct. 10, 2018. The installation of the internal implant is only a small part of the process, as the device itself must be fine-tuned over several months through a process called “mapping or programming.”

“As soon as it was turned on, all I could hear was noise, and I thought to myself, ‘oh no, what have I done.’ It sounded like a really bad mariachi band.” Dolan said. “But before we were done with the programing on that first day, I already felt like it was getting better. And every day since then, it has gotten better and better. And this mapping is really helping a lot.”

Within the first year, Dolan will meet with Fairley for six to eight mapping sessions.

“At their initial activation we have them listen for soft sounds called threshold levels and we try to create a dynamic range to allow them to hear a variety of speech and environmental sound,” Fairley said. “As they become more experienced listeners, their results were way different from day #1 to 3 or 6 months post-surgery. Once they have used the implant for a while, they are better able to discern threshold levels and comfortably loud level and we have to adjust the device to accommodate that, and that’s why we have to see them so often in the beginning. Those levels change so much as the swelling goes down and the healing begins following surgery.”

A cochlear implant is an electronic medical device that replaces the function of the damaged inner ear. Unlike hearing aids, which make sounds louder, cochlear implants do the work of damaged parts of the inner ear (cochlea) to provide sound signals to the brain. The apparatus consists of two components: the external speech processor unit and the internal implant itself, which is surgically placed by an ENT Specialist. The sound processor, worn behind the ear, on the head alone or on the body, captures sound and turns it into digital code. The sound processor has a battery that powers the entire system. The implant converts the digitally-coded sound into electrical impulses and sends them along the electrode array placed in the cochlea. The implant’s electrodes stimulate the cochlea’s hearing nerve, which then sends the impulses to the brain where they are interpreted as sound.

Cochlear implant technology has improved drastically over the last 10 years. While the implant itself remains installed internally, new speech processor units can be utilized or upgraded as we would do with our cell phones. Dolan is wearing the Nucleus 7, a unit that allows him to connect directly to his phone, TV, or computer using Bluetooth technology. “I’m streaming everything already,” Dolan said. “It’s awesome!”

While Dolan had some initial apprehension about undergoing surgery, he said that the care provided by both Tsai and Fairley has helped to ease his mind. “I am very happy with the results, and very encouraged by the improvements that are being made.” Dolan said. Now with his cochlear implants, he can finally experience the one thing that he hasn’t been able to truly enjoy for years: music. “Music has been a big part of my life, and it had gone away,” Dolan said. “I could hear some music, but a lot of it was just noise. I used to have to mute my hearing aids or put on earmuffs because the music was so unbearably loud. I don’t have to do that with the cochlear implants.”

Since Dolan’s successful surgery, the partnership has performed the procedure and more evaluations on several veterans. With the Air Force performing the surgical treatment and the VA providing pre- and post-operative consultation and mapping, more veterans in Southern Nevada are experiencing an improved quality of life and better hearing.